North Carolina Small Business Health Insurance Options

The HSA for America Guide to North Carolina Small Business Health Insurance. This guide is aimed at companies in North Carolina with 30 or fewer employees.

This guide will help independent professionals, small business owners, and freelancers provide the most cost effective set of health benefits for their employees. This will allow you to remain competitive and offer the benefits and compensation packages you need in order to attract and retain the best talent.

North Carolina Small Business Health Insurance Benefits Options

There are many options available to small businesses in North Carolina when it comes time to provide health benefits for their employees.

The most popular, but also the most costly option is to implement the traditional group health plan.

Prices vary depending on age. However, according to from the Kaiser Family Foundation the average cost of group health insurance sponsored by an employer for a worker or family in 2022 will be $22,737. This is $1,360 higher than the average.

North Carolina employees contribute an average of $7,601, or $1,400 more than the national average, towards their health insurance costs.

North Carolina companies also have other options that can reduce costs. They include:

Health Savings Accounts (HSAs)
Health reimbursement arrangements (HRAs)
Direct primary care memberships
Health sharing programs

Your North Carolina small business health Insurance strategy depends on a number of factors, including the size of your company, your budget and your employees’ age and medical needs.

Read on the go, download our Complete Guide To Small Business Healthcare Plans.

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North Carolina Small Business Health Insurance: Geographical Considerations

You should also consider the unique healthcare environment in North Carolina. This includes not only busy cities such as Greenville, Raleigh, and Charlotte but also more rural areas like Ellerbe, Creswell, and other places.

North Carolina’s business owners must therefore carefully consider how they distribute their workforce throughout the state. Executives in Charlotte who are responsible for company headquarters may choose an HMO which restricts employees and their families from seeing doctors outside the network. However, many of these employees and their families reside and work in Lucia and are far away from this plan’s provider network.

North Carolina Small Business Group Health Insurance

Most North Carolina employers choose traditional group health insurance.

Although that’s not the cheapest option.

Here’s how the system works:

Employers contract with third party insurance providers – typically a profit-making corporation – to offer a package of benefits in health insurance for employees and, if desired by the employer, their family members.

The Affordable Care Act requires that employers who have 50 employees or more offer ACA qualified health insurance for all their employees working more than 30 hour per week. Otherwise, they will be penalized.

Health insurance plans must include the 10 minimum essential coverages required by the Affordable Care Act. The ten essential coverages (MEC) are as follows:

Ambulatory Patient Services (outpatient services you receive without having to be admitted into a hospital).
Emergency services
Hospitalization is a term used to describe a hospital stay (such as surgery or overnight stays).
Care of the newborn, both before and after delivery, as well as pregnancy, maternity and postnatal care
Services for mental health disorders and addictions, such as counseling and psychotherapy.
Prescription drugs
Services and Devices for Rehabilitation and Habilitative (Services and Devices to Help People with Injuries, Disabilities, and Chronic Conditions Gain or Recover Mental and Physical Skills)
Laboratory services
Services for prevention and wellness and management of chronic diseases
Children’s services including dental and eye care are covered (adult dental and visual coverage is not essential).

The ACA also requires that health insurance cover birth control and breast-feeding.

Traditional health insurance for business is expensive, but it has the benefit of guaranteed enrollment.

The insurance company can’t deny coverage or raise the premiums if the employee enrolls in the initial enrollment phase when they qualify, during a period of special enrollment triggered by an event that qualifies, or at the open enrollment beginning on November 1st each year.

Small businesses in North Carolina can opt out of health insurance

Employers with less than 50 employees are exempt from offering health insurance.

North Carolina law does not impose any requirements. You don’t need to provide health insurance if you employ fewer than fifty people.

No penalty will be charged.

Even small businesses should offer competitive health insurance, as it can be difficult to retain and recruit quality staff without it.

In North Carolina in particular, unemployment rates are low. And employers compete fiercely for the best talent.

Employers in North Carolina can save money by providing a health-sharing plan or medical cost sharing (more information below) and paying some of or all the expenses for their employees.

The HRA Alternative

If you want to help your employees save money on their health insurance, then you can offer them a QSEHRA.

QSEHRAs can provide the following benefits to employers

1.)No minimum contribution limits

QSEHRAs do not require that you make a minimum contribution each year, unlike pension plans. As an HRA employer, you have the freedom to determine your own budget and alter it yearly based on cash flow.

A QSEHRA gives you control over your budget.

2.) Flexibility

Employees can be offered a higher or lower amount depending on their marital and family status. You could discriminate by giving a bigger benefit to employees with children than employees who don’t have any.

3.) Tax-free treatment for both employers and employees

Your employer contributions will be fully tax deductible. Contrary to cash compensation, employees do not have to pay taxes on QSEHRA benefits if they keep a plan with the minimum essential coverages stipulated in the Affordable Care Act.

A QSEHRA offers a more attractive alternative to a simple health insurance stipend, which employees can use for health insurance purchases or other expenses.

4.) QSEHRAs Encourage Employee Choice

Too many group health plans restrict employees to a small number of health insurance choices.

They’re often expensive and inappropriate for workers because they are chosen by the HR and company management.

QSEHRAs offer workers and their loved ones a vastly increased number of choices, allowing them to find the plan that best suits them.

North Carolina’s taxation of employer health coverage

Both federal and North Carolina laws allow employers to fully deduct health insurance premiums paid as business expenses. Additionally, the employee does not pay taxes on them.

Overall costs of healthsharing plans are lower. They are tax-deductible for employees. However, the employee will be taxed for employer-funded health sharing costs.

Employer health insurance is not always the best option for North Carolina employees

Traditional group health insurance is not usually the best option for both employers and employees.

Cost
Some of the reasons why traditional health insurance is so expensive are due to overkill. Government regulators at Washington and Raleigh have packed health insurance plans with coverages and obligations that don’t make sense for many employees.

For example traditional health insurance companies must price in coverage for drug and/or alcohol addictions and mental illness, as well maternity benefits which many workers may not want or need.

The result? They’re much less efficient, and therefore cost-effective.

Inflexibility
Group health programs tend to be one-size fit all strategies that do not always adequately address employee budgets or needs. By nature, group health plans sponsored by employers tend to provide only one or two options that are not optimal for certain employees.

In some cases workers are better off buying a plan on their own, taking advantage of subsidies available under the Affordable Care Act.

These workers may be better served by a cheaper health sharing plan. These innovative and affordable health insurance alternatives can be a good solution, especially for workers with good health who do not have pre-existing health conditions.

More information on health sharing programs is discussed below.

Administrative burden

The administrative burden of managing a full-fledged healthcare benefit is substantial. This includes managing documentation, ensuring compliance with plans, auditing them to ensure employees aren’t enrolling ineligible individuals, and answering staff members’ questions. This is essential for a smooth running health insurance system within an organisation.

The plans can be a major burden for employers with a small headcount who cannot justify the cost of a dedicated HR team to administer the plan.

Other strategies that business owners may use include Health Reimbursement Arrangements (HRAs) and health care stipends.

These alternative methods encourage workers buy their own health insurance via the Affordable care Act. This could help workers to benefit from subsidies. This removes employers from the process completely, reducing overheads and administrative costs.

North Carolina health sharing plans

North Carolina small business owners can find health sharing plans to be a cost-effective and affordable alternative to the expensive health insurance.

North Carolina companies are increasingly using medical cost sharing as an alternative to group health insurance. This is a great way to save money. Switching from health insurance to health-sharing can often save companies up to 50% in premiums when compared with their traditional group health plan.

North Carolina’s small businesses can save as much as $10,000 annually per employee on coverage for a family, and up to $3,500 annually per employee on coverage for a single employee.

These programs represent a cutting edge method of funding healthcare. They enable companies to offer employees high-quality healthcare and control costs. These programs share resources with other people or groups.

Health sharing programs allow participants to pay a set amount of money each year as opposed to paying for traditional health insurance.

Health Sharing Plans vs. Health Insurance

Health insurance and health sharing plans are different.

Health sharing organizations are instead voluntary associations of like-minded individuals who agree to share the medical expenses incurred by other members. Contrary to health insurers, which are often for-profit companies, health sharing ministry is a non-profit organization.

Mandatory Coverage

While federal and State laws require traditional insurance policies to cover many things people do not want or need, health plans have no such requirements. The ten Minimum Essential Coverage requirements do not apply to health sharing organisations.

It is not necessary for medical cost-sharing to cover addiction treatment costs for people that never use drugs. Also, they do not need to cover any injuries sustained by members as a consequence of their drunk driving.

Pre Existing Conditions

Healthsharing Plans may require waiting periods to share the costs associated with treating pre-existing health conditions.

The waiting period for surgery is often longer, except when the accident or injury could not have possibly been predicted prior to the enrollment of the member.

These waiting times eliminate a significant amount of adverse choice, and they help health-sharing organizations offer a set of great benefits for a fraction as much as the cost of a policy purchased on the Healthcare.gov North Carolina exchange or an unsubsidized ACA group health insurance.

Note: Under the Affordable Care Act, healthsharing plans do NOT qualify for subsidies. Even if people qualify for a government subsidy, switching to a healthsharing plan can be a great deal cheaper.

North Carolina employers often find that switching to health share makes more sense because small group plans are not eligible for a premium credit under the ACA.

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Health Sharing and Network Restriction North Carolina

Health sharing plans can offer greater choice in healthcare providers compared to traditional managed-care plans like HMOs and POS, which are the majority of employer-sponsored health insurance plans.

Healthsharing organizations operating in North Carolina generally do not limit patients to only providers who are part of their network. Health sharing plan participants can pick their own doctor. Giving people the choice of doctors.

Is Health Share Right for Your Company?

Every business has its own unique characteristics. It’s important to carefully analyze the options before choosing a plan.

Business owners in North Carolina can easily get a comprehensive case analysis and specific recommendations for their company and team.

To begin the process, click on this link to set up an appointment with our experienced Personal Benefits managers licensed in North Carolina.

If you’ve prepared a census of your employees, it will be helpful.

In many cases, switching employees to health coverage will result in savings of thousands of dollars. If you have employees who already have health conditions, it may not make sense to share the cost of their coverage.

Consultations and analyses will always be free.

North Carolina Small Business Health Insurance Reimbursements

Health Reimbursement Arrangements, also known as HRAs, are tax-free benefits funded by employers that reimburse employees for their individual healthcare expenses.

Small businesses in North Carolina often drop group health insurance benefits altogether. They instead establish an HRA and use it to give workers cash to purchase their own health insurance on the individual market with pre-tax dollars.

The company can also benefit from the available subsidies, reducing costs for both the employee and the employer.

After paying for the premiums, if any HRA money remains, employees can use it to cover other costs, such as prescriptions, deductibles and co-pays. HRA benefits remain tax-free for the employee.

By offering an HRA instead of a formal health insurance plan for your group, you empower your employees to select the plans that meet their preferences and needs.

Click here for more information about HRAs in small businesses.

QSEHRAs—The HRA for Small Businesses

QSEHRA, or the Qualified small employer health reimbursement arrangement (pronounced “Cue Sarah”) is a type of HRA that can be used by small businesses.

This benefit is for companies that have fewer than fifty full-time workers or the equivalent and do not offer any traditional group health insurance.

Businesses can set their own QSEHRA maximum allowances within certain limits. North Carolina employers will be able to contribute as much as $5,850 per employee (up to $487.50 per monthly) in 2023. They can also contribute up to $11,800 per family.

The employees use this money to buy their own health insurance through the online exchange or a Personal benefits manager on the individual and family market. The employee retains the right to a subsidy that they wouldn’t get under a group health plan paid by their employer.

You can choose to reimburse employees’ health insurance premiums only or their premiums and any additional medical costs.

QSEHRAs & Special Enrollment Periods

You will have to offer your workers a Special Registration Period if your HRA replaces your old health plan. This is a sixty-day window in which your employees may purchase their own ACA approved insurance plan, with guaranteed approval rights.

It will help ensure that your employees are not left without coverage if you decide to replace your existing group health plan with the QSEHRA.

HRA Advantages

Health Reimbursement Arrangements are a great way to save money.

The money you spend on HRAs for your employees can be deducted from your taxes and is tax-free for them.

HRA money is yours until it’s paid out to employees. You can use it as working capital. It is not required to be deposited with a third party.

The HRA benefit can be designed by employers in a way that suits their needs, and includes what expenses they are willing to cover.

The workers’ health insurance is not affected if they change their status to contractor or leave the company. The QSEHRA allows the employee to control and own their insurance policy. Not the employer.

HRA Disadvantages

Some workers may not want to be responsible for researching and choosing their own health plan. Some workers might need help to navigate the transition.

Your HSA for America Personal Benefits manager is ready to assist you. No worker will be left behind.

To schedule an appointment, have your workers Click this Link or call 800-913-0172.

Click here for more information about alternative health insurance plans for small businesses in North Carolina.

The Direct Primary Healthcare Advantage

Direct Primary care plans (DPC) are an alternative model of healthcare that’s growing in popularity throughout the US and North Carolina.

The model is membership-based: For a flat, affordable fee per month, similar to a gym membership for your employees, they receive as many appointments as they require, either personally or via telehealth.

DPC memberships start at $80 per month, making it a very affordable and attractive option to improve your health without copayments.

DPC plans give members access to all routine primary, chronic and pre-ventive care services.

Direct Primary Care Practices provide a wide range of services, including:

Preventive care. DPC physicians emphasize preventive care and offer services such routine check-ups with immunizations or screenings for different conditions.
DPC doctors treat acute illness and injuries like infections, colds or flu, minor injuries and skin conditions.
Chronic disease Management DPC doctors manage chronic diseases like diabetes, asthma, hypertension, arthritis and more. The doctors provide continuous care, monitoring, as well as adjustments to treatment plans when necessary.
Comprehensive physical exams. DPC physicians offer comprehensive physical examinations that assess overall health to identify potential health risks and give personalized health advice.
Urgent care. DPC doctors are often available for same-day or next-day urgent care appointments, allowing patients to receive prompt attention for non-emergency medical issues.
Diagnostic and laboratory testing. DPC physicians may coordinate or offer a wide range of laboratory services, including blood work, urine testing, imaging studies such as X-rays or ultrasounds, and electrocardiograms.
Medication Management DPC physicians can prescribe medications. They also monitor their effectiveness. They can also educate and counsel patients on how to use medications.
Mental Health Services Many DPC clinics include mental health care as part of the comprehensive treatment they provide. DPC physicians may offer counseling, therapy or referrals to mental specialists as needed.
Minor procedures. Some DPC doctors have been trained to perform minor surgeries in their offices, including suturing wounds, removing skin lesions or moles, and joint injections.
Care coordination, referrals. DPC physicians act as patient advocate and coordinate care when necessary with specialists, hospitals, or other healthcare providers.

As there’s not an insurance company involved, you won’t need to worry about deductibles, copays or any other type of insurance. All costs are covered by your monthly subscription. Cash-strapped workers will be able to receive the treatment they need as soon as possible. No longer will they have to put off going to the doctor due to the cost of the copay or the deductible.

If patients need additional coverage, they can opt for supplemental plans that include high deductible plans, accident insurance or health sharing plans. DPC membership includes routine health care. Patients can opt to purchase more affordable coverage, such as healthsharing, rather than traditional health insurers.

Health Savings Accounts

HSAs, or Health Savings Plans (HSAs), are powerful tools in helping workers manage their medical bills and also to lower premiums on workplace health insurance.

North Carolina’s residents and businesses are in desperate need of any tax break. The good news: employer contributions to employee Health Savings Accounts(HSAs), are fully deductible from North Carolina’s corporate income tax.

HSAs let individuals set aside money pre-tax to help pay for future healthcare costs. HSAs may be contributed to by employees as well as employers. However, the annual contribution limit will change every year in accordance with inflation.

HSA funds grow tax-deferred and withdrawals made to pay for medical expenses that qualify are tax-free.

North Carolina Small Business Health Insurance HSA Eligibility

To qualify for an HSA or employer pretax contributions into the HSA, employees need to enroll in a qualified high deductible health care plan (HDHP).

In 2023, an IRS-defined high-deductible health care plan is any plan that has a deductible greater than $1,500 or $3,000 if it’s a family plan.

A HDHP can only have a maximum of $7,500 in annual out-ofpocket expenses. This includes deductibles, copayments and cotinsurance. This limit does NOT apply to out-of network services.

Can I combine HSAs & health sharing?

There is only one major health plan that allows employees to contribute pre-tax money into their health savings accounts: the HSA SECURE plan. It’s available through HSA America.

HSA SECURE Plan allows you to combine the tax-savings and healthcare advantages that come with a Health Savings Account (HSA) with the cost savings benefits of healthsharing.

However, to be eligible, your employees must have a self-employed income or own a small company.

HSA SECURE cannot be used by employees who are W-2. HSA SECURE could be an excellent option for your employee or their spouse if they have their own small business, side hustle, freelance job, or other work. They should also be in good physical health without any pre-existing conditions.

As a small business, you may find that the HSA-SECURE Plan is a fantastic way to save money.

Your employees must enroll in HSA SECURE by themselves. If they have already enrolled and created an HSA you can make pretax contributions in their name up to the annual limits Congress sets every year.

HSA secure is explained in detail by clicking the link.

How Do North Carolina Small Business Health Insurance Benefits Get Taxed?

You now know about the different strategies that small businesses can use to supplement traditional health coverage. Below is a quick table explaining each benefit’s taxation.

Plan Type	Employer	Workers
Traditional health insurance premiums	Tax deductible. May qualify for a tax credit (see below)	Non-taxable
HSA contributions	Tax deductible	Pre-tax, up to certain limits. No income limitations.
Health sharing costs	Tax deductible as a compensation expense	Taxable as ordinary W-2 income
Health reimbursement arrangements	Tax deductible	Benefits are non-taxable to the employee
HSA withdrawals	N/A	Withdrawals for qualified medical expenses are tax-free. Otherwise taxable as ordinary income. A 20% penalty for non-qualified withdrawals applies up until age 65.
Direct primary care costs	Tax deductible as a compensation expense	Taxable to the employee

North Carolina Small Business Health Insurance Care Pyramid

Employee Health Benefits should be designed to cover the entire Employee Healthcare Pyramid. From routine prevention, through access to primary healthcare for maintenance, and early detection, until the catastrophic incident, it must include everything.

North Carolina Small Business Health Insurance Care Pyramid

The left side of this page lists the common insurance-based traditional solutions to each level in the Care Pyramid.

The right side of this page lists a few alternative and more affordable ways to protect employees on each of the Pyramid levels.

Employees can find affordable solutions for each level of the plan with a well-designed plan. It is important that there are no employees who have to go without or delay treatment because they cannot afford the premiums, coinsurance or copay.

The Personal Benefits Coordinator can create for you a unique plan which provides solutions to each of the levels of the Care Pyramid. This is often done at a fractional cost to an employer compared with a conventional group plan.

North Carolina Small Business Health Insurance Tax Credit

Small Business Health Care Tax Credit was passed alongside the ACA and allows small business to claim a tax credit for up to 50 percent of employee health care costs.

The program was designed for businesses that have 25 employees or fewer, and hire workers who are paid lower wages.

Both for-profits and non-profits can generally claim this credit.

*Less than 25 employees with an average annual salary around $53,000, excluding salaries for all the owners. The average number of employees is calculated without including the owners. The “full time equivalents” are used to determine the total number of workers. This means that two employees working half time would be equivalent to one employee who works full-time.

* You must pay at least half the premiums of your employees.

* Make sure that the coverage you offer is Affordable Care Law-compliant and available in the state exchange.

*The Affordable Care act-qualified insurance coverage is available through the state exchange. In North Carolina this would be healthcare.

If an employer employs 25 people or has an average annual wage of $53,000, the tax credit will be eliminated.

How can I get credit for my purchase?

Tax-exempt small business must submit Form 990T for tax purposes, even if they are not required to do so.

You are exempt from taxation on contributions made to your employee’s health coverage.

This year, I haven’t paid taxes on my business. Can I claim the credit for tax?

Yes. The tax credit may be used as a way to reduce income tax liabilities incurred in the prior year, or it can also be carried forward and offset over 20 years.

Credits are refundable if your business is tax exempt.

You can consult with your tax adviser to get the full details of the Small Business Health Care Tax Credit.

Combine North Carolina Small Business Health Insurance Strategies

When it comes to maximizing your health insurance coverage, combining different programs is a wise move.

Combining a variety of healthcare packages allows employers to reduce healthcare costs and provide complete coverage for their employees.

As a cost-effective option, consider combining Direct Primary Care (DPC), a plan for primary care that is low-cost and covers all catastrophic events with a health-sharing plan.

This strategy is more cost-effective for both your company and your employees.

Employees can be given more options and lower costs by allowing them to choose between a health-sharing plan or an individual health plan. They can also fund their Health Savings Accounts (HSAs) if they select a HDHP plan that qualifies for an HSA.

What to Do Now

The best way to proceed is to conduct an employee survey and Contact us and receive a complimentary, free business health plan assessment and recommendation.

Your HSA for America Personal Benefits Manager will review your family and work force with you. They will also discuss your budget, needs, employee contributions, and any existing conditions that need to be taken into consideration when creating a new plan.

Many of our PBMs are successful entrepreneurs and business owners in their own right. They understand what you need as a business leader and how to attract and retain top talent.

Can I offer both health insurance and health sharing?

You can provide both plans side-by-side, so that employees can choose the plan that best suits their needs.

If too many employees choose to opt out of the group health plan, your participation rate could drop below the minimum required for a group plan. You can use an HRA as a reimbursement for the employee’s individual health insurance. This will cost close to the same.

North Carolina Small Business Health Insurance: FAQs

What is the difference between Health Insurance and Healthsharing for Small Businesses?

Healthsharing is an alternative to traditional health insurance, which is offered by insurance companies. Members contribute to a pool to cover one another’s medical costs.

What are the benefits of Health Savings Accounts for North Carolina employees?

HSAs are a way for individuals to save money before taxes to pay future medical expenses. Employees and employers can both contribute to HSAs, allowing for tax benefits and savings on healthcare costs.

Is it a good idea for North Carolina small businesses to offer a Direct Primary Care plan (DPC) alongside other options?

Combining DPC and low-cost options such as health sharing plans, can provide comprehensive healthcare solutions at a cost-effective price for small businesses and employees.

How can I claim the Small Business Health Care Tax Credit (SBHCTC)?

For-profit small businesses can claim the tax credit on their annual income tax returns with IRS Forms 8941, while those that are tax-exempt must file Form 990T.

HSA for America is not a tax advisor. Employers are advised to consult with their tax advisors for complete information about claiming the credit.

Can a small business claim the Small Business Health Care Tax Credit even if it does not owe any taxes to North Carolina?

The Small Business Health Care Tax Credit may be used to offset the income tax liability for the previous year. It can also be carried forward up to a maximum of 20 years.

Does North Carolina have a limit on the size of a small business eligible to receive these programs?

Only employers with fewer than fifty employees are eligible for the Qualified Small Employee Health Reimbursement Arrangement. If you have over 50 employees or your company expands to more than 50 people, you can choose from other HRAs.

You’ll also be required by the ACA to offer a qualified health plan for your workers, or you will have to pay a fine. Speak to your Personal Benefits manager if you plan on hiring your 50th full time worker in the near term. This could have an impact on your plan.

Do health sharing plans have waiting periods for pre-existing diseases?

Some healthsharing plans do have waiting periods before they cover pre-existing medical conditions. For more information, it’s best to consult a Personal Benefits manager or review the plan guidelines.

Can employers in North Carolina contribute to the HSAs of their employees?

Employers can contribute to HSAs of their employees, but only up to the annual limit set by Congress.

Can contributions to HSAs by employers be deducted in North Carolina from the state income tax?

Yes. In North Carolina, employer contributions to employee HSAs can be deducted from the state income tax.

Do health sharing plans cover maternity benefits in North Carolina

North Carolina health insurance plans and healthsharing plans often include maternity benefits, which cover prenatal, labor and postnatal care. Some healthsharing plans restrict the cost-sharing benefits of children born outside marriage.

Can HRAs work with other options for coverage, such as health sharing plans and individual health insurance plans

HRAs are compatible with other insurance options. HRAs can be used to reimburse employees for premiums on individual policies. HRA funds cannot be used directly to reimburse employees for the costs of health sharing plans.

What is an HRA?

HRAs are employer-funded accounts that reimburse employees for medical expenses they incur but which are not covered by insurance. Employers decide what expenses qualify and then contribute money accordingly.

What is the best combination of health insurance options and cost-sharing for my small business?

Do not go alone. Speak to a Personal Benefits manager. They can provide a complimentary analysis and recommendations based on the specifics of your needs, including budget and employee count, as well as any existing conditions. The Personal Benefits Manager can design a plan to maximize value while controlling cost and keeping you competitive.

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